Corneal transplant post-op instructions: lie down

DEAR DR. ROACH:Cataract surgery resulted in edema in my eye, which has not healed after six months. I now require a DSAEK corneal transplant. I've been instructed that after the operation I must lie on my back, looking up at the ceiling for three days, getting up only to eat or go to the bathroom. Is this standard procedure after this surgery? -- M.S.

ANSWER: Corneal edema is a known but unusual complication after cataract surgery -- rare enough that I have seen only one case, despite having monitored several hundred patients through the surgery. Corneal transplant is the appropriate treatment for this complication if other methods have been ineffective.

DSAEK (Descemet's stripping endothelial keratoplasty) replaces the damaged inner part of the cornea only, reducing the need for sutures. Instead of sutures, an air bubble is placed into the eye underneath the graft, and with the patient lying on her back, looking up at the ceiling, the air bubble keeps the graft in place until it attaches and the bubble is absorbed.

My patient was able to resume activities after only two days, but your surgeon knows what is best for you.

DEAR DR. ROACH: I am in need of advice in the opposite direction of what you're probably accustomed to. I want to gain weight! I have always been thin and tall; currently my height is 6 feet, 5 inches, and my weight is 215 pounds. I have an athletic build and work out (weight training mostly) four to six days per week. My metabolism is ferocious. About three months ago, I purchased a weight-gaining protein supplement. One shake mixed with 2 percent lowfat milk is more than 1,000 calories! For one month, utilizing a calorie-tracking app and drinking protein shakes, I was consuming 4,000-5,000 calories a day and burning only 3,000-4,000 calories a day. I gained only three to five pounds in one month! Is there any supplement or dietary food or drink you know of that will decrease my voracious metabolic function? -- J.L.

ANSWER: The first question I would have is, Why do you want to gain weight? At 6 feet, 5 inches tall and 215 pounds, your BMI is 25, which is right in the normal range, so from a medical perspective, I would advise you to keep your weight where it is.

There are medical ways of slowing down metabolism (for example, to make your thyroid less active -- a bad idea), but I would recommend that you accept your body how it is. Metabolism tends to slow down as you get older, and many men in your situation end up gaining weight as their metabolism slows but they continue to eat like they were in their teens or 20s.

If your goal is to gain muscle mass, speak to your trainer about exercise techniques. Adequate dietary protein is essential. But some bodies become very strong without becoming very bulky.

DEAR DR. ROACH: The X-ray from a recent trip to an urgent-care center for a back injury showed bladder calcifications in this 47-year-old male. I have chronic calcium oxalate kidney stone issues. Please tell me what I need to know about the calcifications in my bladder. -- J.P.

ANSWER: Calcium oxalate stones show up on X-rays as calcifications. It's possible you had some stones in your bladder at the time of the X-ray. However, bladder cancer can show up as calcifications as well. Forty-seven is young for the diagnosis of bladder cancer, but I would recommend an evaluation by your internist or a urologist. You may need a CT scan or a cystoscopy, where the urologist looks at the bladder wall with an instrument.

READERS: High blood pressure is one of the most common ailments for the general population. The booklet on it describes what it does and how it's treated. Readers can order a copy by writing: Dr. Roach -- No. 104, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Can. with the recipient's printed name and address. Please allow four weeks for delivery.

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Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Health newsletters may be ordered from www.rbmamall.com.

Dr. Keith Roach

Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Health newsletters may be ordered from www.rbmamall.com.

Last modified: December 11, 2013
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